Surgical difficulty assessment during transalveolar extraction of impacted mandibular third molars using two indices: A prospective comparative study

Abstract Introduction: Assessment of difficulty of surgical transalveolar extraction of impacted mandibular third molar (IMTM) is central in the preoperative planning of the procedure. This is to avoid the risk of accidents and possible complications, so that subjects can be well informed of the potential challenges. Aim: This study aimed to compare the surgical predictive ability of Pederson and Gbotolorun indices. Materials and Methods: This was a prospective comparative study carried out by five investigators. Seventy-seven consenting subjects of 18 years and above, who required surgical transalveolar extraction of IMTM under local anesthesia and who met the study inclusion criteria at the dental clinic of our hospital, were recruited. Sociodemographic, preoperative, clinical, radiological, and intraoperative data were taken. Pederson and the Gbotolorun indices were used to predict the surgical difficulty of all IMTM procedures. Data obtained were analyzed using the IBM SPSS Statistics for windows version 23 software (IBM Corp., Armonk, NY, USA). The two indices and the total operation time were correlated using kappa statistical analysis, while specificity and sensitivity of both indices were calculated using formula. Results and Discussion: Gbotolorun index had a better predictive ability than the Pederson index (sensitivity: 66.7% vs. 40.0%; specificity: 87.1% vs. 69.4%; positive predictive value: 55.6% vs. 24%; negative predictive value: 91.5% vs. 82.7%; predictive accuracy: 83.1% vs. 63.6%; and kappa correlation 67.5% vs. 42.9%). These findings indicate that the Gbotolorun index is more reliable in predicting surgical difficulty for IMTM extractions than the Pederson index. In contrast, the Pederson index exhibited lower accuracy and correlation with the degree of surgical difficulty as observed in this study. Overall, the Gbotolorun index showed superior accuracy in predicting the level of surgical difficulty for IMTM extraction. Conclusion: This study demonstrates that the Gbotolorun index is a more favorable option than the Pederson index for predicting the surgical difficulty of third molar transalveolar extractions prior to the operation. In addition, the study emphasizes the importance of both clinical and radiological features in assessing the surgical difficulty associated with the extraction of IMTM.